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Diagnostic issues in chronic daily headache
G Sandrini1, A P Cecchini, C Tassorelli
1University Center for Adaptive Disorders and Headache, C. Mondino Foundation, Via Palestro, Pavia 3-27100, Italy. gsandrin@unipv.it
Insights
Chronic daily headache (CDH) affects many patients but is not in the current International Headache Society classification. Research suggests CDH often evolves from episodic migraine, necessitating its inclusion in future classifications.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Chronic daily headache (CDH) is a prevalent condition reported by patients at specialty headache centers.
- The term CDH is not recognized in the International Headache Society (IHS) classification from 1988.
- The classification and diagnosis of CDH remain subjects of ongoing debate.
Purpose of the Study:
- To discuss the clinical entity of chronic daily headache (CDH).
- To examine the relationship between CDH and episodic migraine.
- To address the need for CDH inclusion in future IHS classifications.
Main Methods:
- Review of clinical observations from headache centers.
- Analysis of existing literature and diagnostic criteria for headache disorders.
- Discussion of the evolution from episodic to chronic headache patterns.
Main Results:
- CDH is characterized by very frequent, almost continuous headaches.
- In many instances, CDH appears to develop from episodic migraine.
- The transition point between episodic and chronic migraine is often unclear.
Conclusions:
- The existence of chronic daily headache (CDH) is increasingly recognized.
- The current IHS classification needs revision to incorporate CDH.
- Further research and consensus are required for definitive diagnostic criteria.
Abstract:
A number of patients attending specialty headache centers complain of very frequent, almost continuous headaches, which are usually grouped together under the term chronic daily headache (CDH), a category which does not appear in the International Headache Society (IHS) classification published in 1988. More than 10 years later, this issue is still debated, also in light of the foreseen revised classification. Several terms have been used to define the clinical picture of CDH, and different criteria have been proposed for the diagnosis of these forms. In most cases, CDH appears to evolve from an episodic migraine, but the temporal limits between an episodic and a no-longer episodic form of migraine are questionable. Although some theoretic problems remain unresolved, it seems that the next revision of the IHS classification can no longer ignore the existence of CDH.